Inflammation and Heart Disease

Because you care about your health, keeping your cardiovascular system working well is probably a core goal for you. After all, heart disease is the number-one killer of men over age 45 and women over age 65. So you’ll want to know about a new way of understanding the origins of chronic disease that has changed the way we think about preventing heart disease.

Chronic inflammation, a subtle and invisible process that happens at the cellular level, may be a root cause of the most common form of heart disease, coronary artery disease (CAD), in which cholesterol-laden plaque accumulates within the walls of the arteries. Virtually all of the 735,000 heart attacks that Americans have each year are caused by CAD, which kills more than 370,000 of us annually.

Yes, inflammation is a natural process. It’s involved in healing injuries, like a cut on your hand, and helping your body respond to infections. Your body sends immune compounds such as white blood cells to fight off infectious invaders and heal the wound. But chronic inflammation puts your body on alert all the time. It’s like an alarm stuck in the “on” position that tricks your body into attacking itself. Inflammation plays a role in many cases of chronic diseases such as diabetes, stroke, dementia, cancer—and heart disease.

The Living Heart

The inflammatory process that can lead to heart disease begins with subtle changes to the lining of the arteries—changes that you can’t feel. We’re used to thinking of our cardiovascular system in mechanic’s terms—the heart is a “pump,” the arteries are “hoses”—but the truth is that our arteries are made up of living cells that are sensitive to inflammation-causing factors like an unhealthy diet, tobacco use, too little exercise or sleep and too much stress or body fat.

The presence of blood cholesterol alone doesn’t always mean clogged arteries, but when there’s chronic inflammation in our bodies, our arteries may respond to cholesterol differently. It’s not a mechanical process, in which our arteries just slowly “fill up” with cholesterol. Rather it’s a dynamic one, created by the body’s wayward attempt to heal itself.

Here’s how it works: The lining of an inflamed artery puts out a protein that causes low-density lipoprotein (LDL), or “bad” cholesterol, to adhere within its walls. White blood cells migrate to the scene, embedding themselves in the arterial walls to engulf the LDL. That sets in motion a process that, over time, converts LDL into plaque within the artery walls. Then, “more white blood cells attack the plaque as though it were a germ,” explains Mark Liponis, M.D., Canyon Ranch physician (1994 – 2018), and “in doing so, they make the plaque more liquid and more unstable.”

Eventually, the plaque ruptures through the artery walls like a pimple bursting through skin, and a blood clot forms to seal the hole. These clots can block blood flow entirely and cause a heart attack. The inflammatory process also damages the lining of the arteries which can lead to problems controlling blood pressure and regulating blood sugar.

Not to be overlooked, the beginnings of heart disease itself, without the initial presence of substantial inflammation, can breed inflammation that can accelerate and worsen one’s case.

Calming Inflammation, Protecting the Heart

The power of a healthy lifestyle lies, in part, in its ability to reduce inflammation many years before it leads to heart problems. We share important lifestyle changes, like eating a healthy diet, exercising, lowering stress and getting a good night’s sleep, in our article Inflammation: The Silent Risk Factor. Adopting any of these habits will be good for your heart, but there are a few anti-inflammatory steps that are particularly heart-healthy:

Consider getting a high-sensitivity C-reactive protein test. This measure of body inflammation, which catches even low levels, isn’t something all doctors regularly use to gauge heart disease risk, so be sure to ask for it. If your result is at or above 0.7 milligrams per liter, it’s a sign that your immune system could be attacking plaque in your arteries and setting you up for a heart attack, Dr. Liponis says.

Lose belly fat. We used to think of fat as simply stored energy, but the fat we carry deep in our abdomens turns out to be biologically active, pumping out inflammatory messengers. A waist circumference of 40 inches or more for a man, and 35 or more for a woman (who isn’t pregnant), is linked with an increased risk for coronary artery disease, high cholesterol, high blood pressure and diabetes. While you can’t spot reduce, when you lose weight, it tends to come off the middle first.

Eat fish as part of a heart-healthy anti-inflammatory diet. Omega-3 fatty acids found in cold-water fatty fish such as salmon lower blood fats (triglycerides) and help prevent blood clots, in addition to their anti-inflammatory effects.